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Original research
Hematologic changes after splenectomy for ovarian cancer debulking surgery, and association with infection and venous thromboembolism
  1. Olga T Filippova1,
  2. Sun Woo Kim2,
  3. Renee A Cowan1,
  4. Andrew J Chi3,
  5. Alexia Iasonos4,
  6. Qin C Zhou4,
  7. Vance Broach1,
  8. Oliver Zivanovic1,
  9. Kara Long Roche1,
  10. Yukio Sonoda1,
  11. Ginger Gardner1 and
  12. Dennis S Chi1
  1. 1Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
  3. 3Bates College, Lewiston, Maine, USA
  4. 4Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Dennis S Chi, Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; chid{at}mskcc.org

Abstract

Introduction The spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The aim of the study was to correlate hematologic changes with the development of infection and venous thromboembolism in patients undergoing splenectomy.

Methods This single-institution retrospective review includes all patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer, March 2001 to December 2016. We compared postoperative hematologic changes (evaluated daily before discharge) in patients developing infection within 30 days' post-surgery (Infection group) with those who did not (No-Infection group). We also compared patients developing venous thromboembolism with those without.

Results A total of 265 patients underwent splenectomy. Median age was 64 years (range 22–88): 146 (55%) patients had stage IIIC and 114 (43%) patients had stage IV. The majority, 201 (76%) patients underwent splenectomy during primary debulking. A total of 132 (50%) patients comprised the Infection group (most common: urinary tract infection, 54%). Median time from surgery to infection was 8 days (range, 0–29). After initial rise in white blood cell count in both groups, the Infection group had a second peak on postoperative day 10 (median 16.6K/mcL, IQR 12.5–21.2) not seen in the No-Infection group (median 12K/mcL, IQR 9.3–16.3). A total of 40 (15%) patients developed venous thromboembolism, median time of 6.5 days (range, 1–43). All patients demonstrated a continuous rise in platelets during postoperative days 0–15. Thrombocytosis was present in 38/40 (95%) patients with venous thromboembolism vs 183/225 (81%) patients without (P=0.036). Median days with thrombocytosis was higher in venous thromboembolism (8 days, range 1–15) vs non groups (6 days, range 1–16, P=0.049).

Conclusion We identified initial leukocytosis after splenectomy in all patients. The Infection group had a second peak in white blood cell count on postoperative day 10, not present in the No-Infection group. Among patients with venous thromboembolism, thrombocytosis was more frequent and of longer duration.

  • ovarian cancer
  • surgery
  • surgical procedures, operative

https://doi.org/10.1136/ijgc-2020-001368

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    Footnotes

    • Twitter @VanceBroach

    • Contributors OTF: Analysis and interpretation of data; drafting of manuscript; revising manuscript critically for important intellectual content; final approval of version to be published; and agrees to be accountable for all aspects of the work. SWK, AJC: Collection of data; final approval of version to be published; and agree to be accountable for all aspects of the work. RAC: Collection and interpretation of data; revising manuscript critically; final approval of version to be published; agrees to be accountable for all aspects of the work. AI, QCZ: Analysis and interpretation of data; revising manuscript critically; final approval of version to be published; agree to be accountable for all aspects of the work. VAB, OZ, KCLR, YS, GJG: Interpretation of data; revising manuscript critically; final approval of version to be published; agree to be accountable for all aspects of the work. Dennis S. Chi: Conception and design; analysis and interpretation of data; revising manuscript critically for important intellectual content; final approval of version to be published; agrees to be accountable for all aspects of the work.

    • Funding This study was funded in part through the NIH/NCI Support Grant P30 CA008748.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.